Long-term risk of upper gastrointestinal bleeding after Helicobacter pylori eradication: a population-based cohort study

Background The long-term effects of H. pylori eradication in preventing upper GI bleeding (UGIB) remains unknown. Aim To determine the long-term risks of UGIB after H. pylori eradication Methods We included all patients who had received clarithromycin-containing triple therapy for the treatment of H. pyliori infection between 2003 and 2012, without subsequent need for re-treatment. We included a propensity score (PS)-matched endoscopy cohort of H. pylori-negative patients as controls. The primary endpoint was the risk of subsequent UGIB. A multivariable Cox model was used to compute the hazard ratio (HR) of UGIB. Results We included 62 738 H. pylori-eradicated and 62 738 PS-matched H. pylori-negative patients, with a median follow-up of 8.1 years (IQR 5.5-10.6). The incidence of UGIB was 20.8 (95% CI 19.5-22.1) and 13.6 (95% CI 12.7-14.7) per 10 000 person-years in H. pylori-eradicated and H. pylori-negative patients, respectively. Compared to controls, H. pylori-eradicated patients had a significantly higher risk of UGIB (HR: 1.65, 95% CI 1.49-1.83). The risk of UGIB in H. pylori-eradicated patients increased after the first 2 years of follow up (HR: 2.18, 95% CI 1.91-2.49). Age-stratified analysis showed that patients >45 years had higher UGIB risk, even after eradication. Conclusions Despite H. pylori eradication, the long-term risk of UGIB was still higher than in H. pylori-negative control subjects. The protective effects of eradication therapy in preventing UGIB appeared to be limited to younger patients, and to within the first 2 years after eradication.

Automated summary

This study found that even after H. pylori eradication therapy, the long-term risk of upper gastrointestinal bleeding was still higher than in H. pylori-negative control subjects. The protective effects of eradication therapy in preventing upper GI bleeding appeared to be limited to younger patients and within the first two years after eradication.